# JASON SHUPE, D.O., AN OSTEOPATHIC CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992366223
- **Authorized official:** JASON SHUPE DO (CEO)
- **Authorized official phone:** (909) 248-3437

## Contact information

- **Practice address:** 554 E FOOTHILL BLVD STE 120, SAN DIMAS, CA 91773-1222
- **Practice address phone:** (909) 248-3437
- **Practice address fax:** (844) 380-6565
- **Mailing address:** 554 E FOOTHILL BLVD STE 120, SAN DIMAS, CA 91773-1222
- **Mailing address phone:** (909) 248-3437
- **Mailing address fax:** (844) 380-6565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 06/26/2019
- **Last updated:** 06/26/2019